Download Treatment and harm reduction responses in the EU

Monitoring drug use, health problems and
responses in prison population in Europe
Dagmar Hedrich, Linda Montanari, Alessandra Bo, Bruno Guarita, Chloé Carpentier,
Isabelle Giraudon, Luis Royuela, Lucas Wiessing
« Good prison health – Better Public health – Safer Society »
Oslo – 24 November 2009
EMCDDA
(European Monitoring Centre for Drug and Drug Addiction)
• A decentralised agency of the European Union, established in
Lisbon 1995 with about 100 staff
• Mission: to collect, analyse and disseminate objective, reliable
and comparable information on drugs and drug addiction and
their consequences
• To promote exchange of best practice
• Audience: policy makers, scientists and researchers,
practitioners and the general public
• Based on a network of national institutions (30 countries)
The REITOX Network
Austrian Health
Institute
Scientific Institute
Public Health
Institute for
Therapy
Research
University Mental
Health Research
Institute
Min. of Health
Drug Control
Department
Direction de la
Santé
Nat. Bureau
for Drug
Prevention
Nat. Monitoring
Centre for Drugs
and Drug Addiction
Estonian Drug
Monitoring
Centre
National
Commission for
Dependencies
Secretariat
Nat. Drug
Commission
Min. of Health
Nat. Centre for
Epidemiology
Trimbos Institute
Portuguese Institute Institute Public
Health
for Drugs & Drug
Addiction
National Board of
Health
Board of Ministers
for Drug
Dependencies
and Drug Control
French Observatory
for Drugs & Drug
Addiction
State Centre
Prevention & Rehabilitation Activities for Drug abuse
Prevention
Coordination Unit
Health Research
Board
SIRUS
National R&D Centre
for Welfare & Health
National Centre
for Addictions
European
Commission
Government Deleg. National Institute
to the National Plan of Public Health
on Drugs
Dept Min.
of Health
National AntiDrugs Agency
Prison Population Rate in the European
countries (27 MS + Hr, Tk)
SE
Below 100 per 100.000 pop
FI
NO
Between 100-150 per 100.000
population
EE
LV
Between 151-200 per 100.000
population
DK
LT
IE
More than 201 per 100.000
population
UK
UK
PL
NL
BE
DE
BE
FR
CZ
SK
AT
HU
RO
SI HR
BG
LU
PT
IT
TR
ES
Source: Council of Europe Annual Penal Statistics (SPACE I) 2006
Population demographic data: EUROSTAT
EL
MT
CY
Prison Population Rate in the EU27 by country
(*100 000 population)
Prison population rate
350,00
300,00
250,00
200,00
150,00
120
100,00
50,00
0,00
SI
IT
DK
FI
IE
CY
SE
MT
HR
GR
FR
TR
BE
DE
AT
EU
PT
NL
Source: Council of Europe Annual Penal Statistics (SPACE I) 2006
Population demographic data: EUROSTAT
UK
ES
HU
BG
SK
LU
RO
CZ
PL
LT
LV
EE
Drugs as a major factor in imprisonment in EU
• Most EU countries: 10-30% of all sentenced inmates convicted
for drug offences (SPACE, 2006)
• Drug offences represent the main reason for entering prison
• Plus property crime (robbery, burglary, etc.) to support a drug
addiction
• Considerable differences between detention centres and
between countries
• Countries with highest rates of drug offenders are the drug entry
or transit countries
Drug use in prison population (some studies
since 2002)
• Before prison:
• Half of those surveyed in prison were regular drug users
• Over a third have injected drugs
• Current drug use (LYP-LMP): 10-48% males and 30-60%
females (Fazel et al. literature review)
• Within prison:
• 1% to 50% have used drugs
• Up to 12% reported a daily use in the last month (one study)
• 1%-31% have injected a drug at least once (selected
samples)
Source: EMCDDA Annual Report 2008, Statistical Bulletin
Patients entering drug treatment in prison in
2007 in 5 countries (Ge, Fr, Cy, Sk, Sw)
• 3274 drug clients (22% new) (from 95 Cy to 625 in Fr)
• 91% males (from 87% in Sk to 99% in Cy)
• Mean age: 32 y. males and 34 y. females
• Primary drug (relevant differences between countries):
•
28% opioids; 24% stimulants; 17% cannabis; 7% cocaine; 24% other drugs
• More females (35%) than males (28%) opioid users
• 36% injectors of primary drug among patients entering treatment
in prison (similar to patients outside prison)
HIV prevalence in IDUs in prisons and among
IDUs outside prison
Country
Year of study
Sample size
% positive
Belgium – Flemish
Community
1999
316
0.3%
0.5% - 1.9% (186 – 623)
Belgium - French
Community
2001
573
1.1%
3.4% (267)
Bulgaria
2006
613
0.0%
0.8% (487), Sofia
Czech Republic
2002
674
0.4%
0.1% (3100)
Germany – Berlin
2000
152
18.0%
3.2% (2350)
Ireland
1999
173
5.8%
3.5% (509), 1998
Spain
2006
1194
39.7%
36.4% (9068)
Luxembourg
1998
116
4.3%
3.5% (142)
Malta
2004
58
0.0%
1.3% (77)
Finland
2007
1363
0.1%
0.2% (1486), 2006
UK – E&W, ever IDUs
1998
775
0.5%
0.9% (3366)
Croatia
2007
200
0.0%
0.0% (128), Zagreb
Source: EMCDDA Annual Report 2009, Statistical Bulletin
Prevalence in IDUs outside
prison (n)
HCV antibody prevalence in IDUs in prisons
and among IDUs outside prison
Country
Year of study
Sample size
% positive
Belgium – Flemish Community
1999
321
17.4%
37.9% (195)
Belgium – French Community
2001
603
27.7%
-
Bulgaria
2006
614
17.9%
52.4% (487), Sofia
Czech Republic
2002
1319
52.0%
29.9% (686)
Germany – Berlin
2000
154
82.5%
-
Ireland
1999
173
71.7%
72.3% (65), Dublin 2003
Greece
1999
130
63.1%
51.7% (286)
Italy - Brescia-Mombello Monza
Milano-Opera
1999
165
64.2%
-
Luxembourg
2005
108
90.7%
81.3% (268)
Malta
2004
58
50.0%
34.4% (180)
Finland
1999
134
52.0%
38.4% (146)
Sweden - Gothenburg
2007
56
32.1%
-
UK – Scotland, mainly Glasgow
1999
84
42.0%
46.9% (348)
UK – E&W, ever IDUs
1998
805
29.8%
41.0%
Croatia
2007
200
44%
Source: EMCDDA Annual Report 2009, Statistical Bulletin
Prevalence in IDUs outside
prison (n)
(3366)
-
HBV antibody (aHBc) prevalence in IDUs in
prisons and among IDUs outside prison
Country
Year of study
Sample size
% positive
Prevalence in IDUs outside
prison (n)
Germany – Berlin
2000
151
53.0%
-
Ireland
1999
173
17.9%
-
Greece
1999
130
52.3%
29.1% (1013), 2006
Luxembourg
2005
103
35.9%
24.7% (239)
Sweden
1997
184
57.6%
-
UK – England & Wales
(ever IDUs)
1998
805
19.9%
22.0% (3363)
Croatia
2007
200
24.0%
-
Source: EMCDDA Annual Report 2009, Statistical Bulletin
Mortality among prisoners and drug related
deaths after release from prison
•
Poor health of prisoners, especially drug users, and higher mortality
rates compared to general population
•
High drug-related post-release mortality rates compared to general
population
•
Standardised mortality ratio (SMR) comparing drug related deaths of
released prisoners with a reference population
• England and Wales (Farrel et al., 2007):
29 males and 69 females (one
week after release)
• Denmark (Christensen at al., 2006):
29 (males and females; first two
weeks after release)
• France (Verger at al., 2003):
124 males 15-34 years and 274
males 35-54 years (first year
after release)
EU policy framework on drugs and prison
I. Council Recommendation of 2003 on prevention and
reduction of health-related harm
II. EU-Drugs Strategy 2005 – 2012:
• EU-AP 2009-2012: Objective 9: “provide access to health care
for drug users in prison”
•
(21) develop services for drug users in prison equivalent to services outside
prison in order to reduce drug related health problems; particular attention
to period after prison release
•
(22) implement indicators to monitor drug use, health problems, service
delivery
Services provided to prisoners in European
countries
•
•
•
•
•
•
Information on drugs and health
Screening for infectious diseases and vaccination
Detoxification
Substitution treatment
Drug-free treatment approaches
Preparation for release
• Relevant differences between countries and detention
centres in level of provision
Availability of substitution treatment in the prison system
(2006 data)
Substitution/maintenance is not
available in prisons
Exists in just a few prisons
LU
FI
SE
Exists in more than a few prisons but
not in a majority of them
NO
EE
Exists in a majority of prisons (but not
in nearly all of them)
LV
DK*
Exists in nearly all prisons
UK
IE
LT
PL
NL
BE
DE
CZ
SK
HU
AT
FR
SI HR*
RO
IT
PT
BG
ES
EL
TR
CY
MT
(Source: Expert Rating; Reitox National Focal Points, 2008)
Provision of substitution/maintenance treatment (OST) in
the community and availability of OST programmes in the
prison system in 2007 (expert rating)
Level of provision of selected health responses to
prisoners in 28 European countries (n. countries)
Individual counselling on
infection risk
Pre-release counselling on
0 2
overdose risk
Prison needle and syringe
0 2
exchange programmes
0
Full
Extensive
1
4
6
10
6
0 2
7
11
4
4
1
22
2
5
Limited
10
Rare
15
Does no exist
20
25
No information
Source: EMCDDA Annual Report 2009; expert rating on 26 EU MS + Norway and Turkey
Conclusions
•
Drug use is major factor of imprisonment in Europe
•
Drug users represent a substantial proportion of the prison population
•
Health related problems, especially infectious diseases, more common among
prisoners than among drug users in the community or in the general population
•
Drug related mortality is high, especially in the immediate period after prison
release
•
Interventions for drug users in prison (drug treatment and health interventions) still
not widely available in European prisons, but some European countries have
several interventions options
•
Need to for more comparable European information on drug use and responses in
prison
•
Monitoring and research should be improved at European level
Thank you four your attention
www.emcdda.europa.eu
[email protected]